Abstract | OBJECTIVE: To provide a state-of-the-art review of high-frequency oscillatory ventilation in the management of pediatric patients with respiratory failure. DATA SOURCES: A thorough analysis of the preclinical and clinical literature regarding the pathophysiology of respiratory failure and the efficacy of high-frequency techniques in the neonatal and pediatric populations. DATA SYNTHESIS: After an overview of the introduction of high-frequency techniques, the following topical areas are addressed: device vs. strategy, indications for use, disease-specific strategies, additional practical considerations, and the future of high-frequency techniques. CONCLUSIONS: The ideal ventilatory approach in patients with hypoxemic respiratory failure may be early institution of an "open lung" strategy using high-frequency ventilatory techniques. The mechanisms of gas exchange that are most important during high-frequency ventilation are bulk axial flow, interregional gas mixing, and molecular diffusion. Infants with hyaline membrane disease and congenital diaphragmatic hernia have also responded positively to the implementation of high-frequency techniques. The oxygenation index (mean airway pressure x Fio2 x 100/Pao2) provides useful prognostic information in patients being managed with high-frequency oscillatory ventilation and may help to identify those patients with high predicted mortality to offer additional or experimental therapies. In the future, the combination of high-frequency oscillatory ventilation and partial liquid breathing offers the possibility of partitioning the physiologic changes associated with positive pressure ventilation. This approach may prove to be the ultimate lung-protective ventilatory strategy.
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Authors | J H Arnold |
Journal | Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
(Pediatr Crit Care Med)
Vol. 1
Issue 2
Pg. 93-9
(Oct 2000)
ISSN: 1529-7535 [Print] United States |
PMID | 12813257
(Publication Type: Journal Article)
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